Leaders at four academic drug centers have proposed that colleagues battle high cancer drug prices by resisting the temptation to sell promising candidates to the highest bidder. Instead, they advocate for enlisting generic and biosimilar drugmakers to produce de-risked candidates governed by price-capping agreements. Near-term repurposing of patent-expired drugs for new indications could also help, they said in a commentary published in the Feb. 9 edition of Cell.

"How Much Longer Will We Put Up With $100,000 Cancer Drugs?" the authors ask in the commentary's pointed title. A definitive answer would move markets and never arrives in the five-page essay. What does materialize is a proposed role for academic researchers in shortening the time to delivery of lower-cost cancer drugs.

Blending U.S. and European perspectives on the topic, the authors — from the U.K.'s Institute of Cancer Research, the Netherlands Cancer Institute, Utrecht University and the University of Texas MD Anderson Cancer Center — propose two key actions for colleagues who share their concerns.

Most ambitiously, they suggest that academics "abide by their societal responsibility and resist the temptation to sell their drug candidate to the highest bidder," a potentially tough choice for scholarly researchers and institutes beset by ever-more intense interest in early stage work from venture capitalists and biopharma companies.

Making agreements on price caps part of the negotiations with potential investors and companies advancing endemically discovered drugs is another key element, they wrote. Though potentially a tall order given the fiduciary duty most companies carry to prioritize shareholder returns, the authors proposed a solution: enlisting generic and biosimilar drugmakers "used to working with lower profit margins" in their quest. The approach could be especially attractive when "drugs have a strong mechanistic rationale and an associated biomarker of response," the authors wrote.

Giulio Draetta, director of the Institute for Applied Cancer Science at MD Anderson, is a co-author of the commentary. The authors' aim, he told BioWorld Today, is to suggest that by pursuing development much more prudently, killing projects early when the biologic rationale doesn't hold up and applying more stringent standards along the way, there can be a lowering of not just development costs but, ultimately, the cost of drugs that are brought to market.

"I think there's a need for re-balancing," Draetta said. "As much as I love this idea of free enterprise and everyone trying to think outside the box and being entrepreneurial, the reality is that this is not sustainable."

Lest anyone mistake Draetta as being out of touch with industry imperatives, he carries substantial commercial credibility, built during stints as co-founder and vice president of research at former drug discovery firm Mitotix Inc., Pharmacia (bought by Pfizer Inc.) and Merck KGaA, where he served as vice president and global head of oncology drug discovery. (See BioWorld Today, Dec. 10, 2012.)

Building the collection of academic centers required to drive the scale needed to produce significant numbers of drug candidates will take time and money, Draetta and his co-authors recognize. But creating such groups "alongside generics partners or newly created commercial entities will create competition and drive down prices in conventional pharma and biotech," they wrote.

In the near term, they propose, there should be more focus on repurposing off-patent drugs by finding new indications linked to biomarkers that effectively predict response. "Academic consortia should also focus on finding effective combinations for drugs that were abandoned for lack of single-agent activity," they suggest.

While targeted drugs and immunotherapies have delivered significant benefits to cancer patients, "the spiraling prices of these new drugs threaten the financial sustainability of cancer treatment," they wrote in framing their proposals. With redundant trials, counter-productive organizational pressures and a "herd mentality" driving inefficiencies in commercial development, the authors said they see plenty to fix.